Home Library Service Application Form Please note: Thank you for your interest in our Home Library Service. As there are no spaces currently available, your application will be placed on a wait list. A staff member will be in contact when we are able to provide the service to you. Personal DetailsName First Last Date of birth:*Address Street Address Address Line 2 Suburb State Postcode PhoneEmail Borrower No:*Living StatusI live in a private homeI live in a retirement villageI live in a nursing homeI live aloneI live with familyI live with othersTransport StatusI drive my own carI travel with a carer/family memberI travel via public transport – bus, taxi, etcI travel via village/home transportI have no access to transportI am not able to travel on public transportOther I have access to the internet I receive in-home carer or respite services I attend out-of-home respite services Please list any relevant medical conditions and/or physical/cognitive disabilitiesService RequirementsDelivery service options:Library staff selectionSelf-selection of resources made in person (or by representative) at the librarySelf-selection of resources made online via the library catalogueClient to collect from:Ipswich CentralRedbank PlazaRedbank PlainsSpringfield CentralRosewood LibraryLibrary staff selection and delivery of resourcesInstructions for Item SelectionFictionFormat Audio Books Ordinary Print Books Large Print Number of Audio Books*Number of Ordinary Print Books*Number of Large Print*CategoriesUse Ctrl+Click to select multiple categoriesGeneral FictionRomanceWarHistorical FictionHistorical RomancesAustralianaMysteryFamily SagasFantasyWesternsScience FictionSpy/EspionageBiographyShort StoriesPicture BooksFavourite Authors:Non-FictionFormat Audio Books Ordinary Print Books Large Print Books Number of Audio Books*Number of Ordinary Print Books*Number of Large Print*List SubjectsOther DVDs CDs Magazines Number of DVDs*Number of CDs*Number of Magazines*Any Further DetailsHard/Soft Cover, Size/Weight, etc: DeclarationI have read/I am aware of Ipswich City Council's Privacy Policy and agree to conform to the rules of Ipswich Libraries and to pay any fines and make good any damages or loss which I may justly be charged.
